Celebrating India's National Doctors' Day with Dr. Karthikeyan Ramachandran, MD

India celebrates National Doctor's Day to honor and show gratitude to all the doctors for their hard work and contributions. One such exemplary figure is Dr. Karthikeyan Ramachandran, a pioneer in physical medicine and rehabilitation.

About Dr. R. Karthikeyan, MD

He is an Associate Professor and Head of the Department of Physical Medicine and Rehabilitation at SRM Medical College Hospital and Research Centre, Kattankulathur, Tamil Nadu as well as India Senior Consultant of Rehabilitation Medicine with SRM Global Hospitals.

Dr. R. Karthikeyan's areas of specialization are Neuro rehabilitation in spinal cord injury, stroke and traumatic brain injury, intervention pain management, legal aspects of disability, technology in healthcare and rehabilitation medicine, ethics, and research in rehabilitation. His areas of interest and expertise are in the application of information technology, artificial intelligence, and machine learning in healthcare and medical education. When it comes to his interest in rehabilitation engineering, it involves designing rehabilitation aids with robotics technology.

In this interview, he shares his thoughts about changing healthcare technology, digital health, how ABHA is shaping India's future of healthcare, the implementation of UHID, and AI potential in the healthcare industry. At the end of this article, you will get insights and valuable perspectives on the evolving landscape of healthcare in India.

Hello, Dr. Karthikeyan Ramachandran. As we all know, you're one of the very few doctors in India who pursued a master's in physical medicine and rehabilitation. 

What inspired you to pursue this career in physical medicine and rehabilitation?

In healthcare, the rehabilitation phase is very important to keep up one's quality of life, especially after a debilitating disease. With an advanced health delivery system in terms of infrastructure and skill sets, we are able to save lives more than before, reducing mortality significantly. Now we are in a stage to plan how to bring back a better quality of life among those people, where the specialty physical medicine and rehabilitation plays a vital role.

For example, if a person has a heart attack, with emergency medical intervention, their life can be saved. Now, their concern would be whether their heart is fit enough for the rest of their life, what activities they can and cannot do. In this case, training their heart to regain its potential is significant, which is done as cardiac rehabilitation.

Likewise, we commonly see people with residual impairments or disabilities after a stroke, traumatic brain injuries, spinal cord injuries, or old age geriatric disorders. These really make themselves and their families face a lot of hardships in society. It is highly important to manage these people to prevent further complications and improve their functional abilities. When all other branches add years to life, physical medicine and rehabilitation is the one that adds life to years. I felt that these reasons were enough to take up physical medicine and rehabilitation as my specialty of interest.

I feel so positive that the awareness regarding physical medicine and rehabilitation is increasing among the medical community and common people. In fact, many young doctors have started to take up this specialty as their interest.

What are your thoughts about the changing healthcare technology landscape in India?

In India, the healthcare system is complex and highly dynamic with public and private sectors serving the 1.4 billion population in our country. It includes primary, secondary, tertiary, and quaternary care.

Being more diverse with our health needs, from communicable diseases to non-communicable lifestyle diseases, we are able to manage our health metrics efficiently with timely adoption of technology in healthcare. Despite certain challenges, such as accessibility and affordability, technology has percolated healthcare in a significant manner from diagnostics to therapeutics. Especially, the advancements in medical imaging and vaccine production have revolutionized healthcare, which was evident during the past COVID pandemic.

Medical devices, smart wearables with remote monitoring, electronic health records (EHR), telemedicine, internet of medical things (IoMT), artificial intelligence, and machine learning are the areas where India is progressing well. It is imperative that we encourage interdisciplinary research and development with medical professionals and technical experts.

It is so promising to see that our government agencies, private organizations, and venture capitalists are showing significant interest in incubating and evolving an ecosystem for indigenous healthcare technology, paving the way for innovations that make our healthcare more accessible, cost-effective, and with good patient safety.

According to you, what is digital health, and why is digital health important?

Digital health is all about implementing information and communication technology (ICT) through hardware and software for an efficient healthcare delivery system. (On a lighter note: digital health is managing health with ease at your digits—the finger tips.)

Common digital health modalities include electronic health records, mobile applications, telemedicine/telehealth, smart wearables with remote monitoring, machine learning, and artificial intelligence in healthcare.

When digitalization got into other domains, like banking, there was an inertia for accepting technology in healthcare due to various reasons, mainly the availability of technical infrastructure, affordability, and the attitude of the stake holders. But now, the medical community and common people started accepting health digitalization after realizing its advantages. In healthcare, the main advantage of digitalization is the instant communication and analysis of health data, which directly or indirectly helps save lives. This is something very important.

India has around 1 billion mobile users, out of which around 650 million are using smartphones, which is the second highest in the world. We strongly believe that digital health, especially through smartphones, would be the most efficient mode to connect with our people to strengthen our healthcare system.

We can mention a few important areas where digitalization can really make a positive impact in Indian healthcare: data management, health equity, home care with remote monitoring, and medical tourism.

Data management

India being a vastly populous country with varied geography, culture, lifestyle, and socio-economics, the foremost thing we need is health data. Health data is an important requisite for medical education and research, planning any social health interventions, policy making, and predictive data analytics.

Health data should be matured with uniformity in data capture, validation mechanisms, easy data transfer, and communication. When we list all these requisites for an ideal data set, it can be done only with the technology of digital health. For example, at some point in time, when we want to know the eating habits of our people to assess the risk factors of lifestyle diseases like diabetes and hypertension, no one has and no one can provide such centralized data except the online food delivery platforms.

Equity in healthcare

It is worth appreciating that the doctor population ratio in India stands at 1:834, which is better than the WHO standard of 1:1,000. But the availability of healthcare facilities and medical experts is not uniform throughout the country. Digital health, as telehealth or telemedicine, is the most efficient way to bridge this gap and achieve health equity in our country with its high population, wide geographical variations, and urban-rural disparity.

With telehealth, a person in a remote village can consult a specialist in a tertiary care hospital in a metropolitan city very easily. Moreover, telehealth can also help us in a big way with community health interventions and primary care. Recognizing the importance of telehealth, our government of India released its guidelines in the year 2020, which were very useful during the peak period of the COVID pandemic. In fact, the WHO Global Strategy on Digital Health 2020–2025 stresses the importance of digital health as an efficient mechanism for universal health coverage.

Home care with remote monitoring

Considering the cost of institutional care in hospitals, well-equipped home care or assisted living with healthcare services on their mobile phones is the growing trend as of now. At present, any health seeker can consult a doctor and get their medicines delivered at home with a mobile in their hand. If it is extended care after hospitalization in conditions like post-stroke rehabilitation and geriatric ailments with physical and cognitive deficits, assistive smart technology, wearable devices, and remote monitoring will be very useful.

Digital health should be an integral part of a health system that is ethical, safe, secure, reliable, equitable, and sustainable. It should be developed with principles of accessibility, transparency, scalability, interoperability, replicability, privacy, security, and confidentiality.

How is ABHA shaping India's future healthcare?

ABHA is the Ayushman Bharat Health Account, which has a 14-digit number that uniquely identifies a person as a participant in India’s Digital Healthcare Ecosystem. It is an integral part of the Ayushman Bharat Digital Mission (ABDM) in accordance with the National Health Policy 2017.

As of now, hospitals, both public and private, service providers, insurance companies, and healthcare professionals function in silos with gaps in communication and coordination. To overcome this, ABHA integrates all the stakeholders in healthcare under one platform that aims to provide a seamless and efficient health data exchange of personal health records (PHR) based on an individual’s informed consent (with an ABHA address).

With one unified payment interface (UPI), we transact with multiple bank accounts, which is the same way ABHA works. That is, all your health records (like prescriptions, lab test results, and vaccination certificates) are in one safe place, irrespective of the hospitals where you consult. And it can be accessed online anytime, anywhere, and by anyone with the user’s consent. No more carrying all your health records in your hand whenever you go to the hospital. It’s a transition in health records from service provider-centric to user-centric.

Along with the integration of public health programs, the Ayushman Bharat National Health Protection Mission offers insurance covers over 12 crore poor and vulnerable families (approximately 55 crore beneficiaries), providing coverage up to 5 lakh rupees per family, per year. It also facilitates insurance coverage with impaneled private insurance, which curtails out-of-pocket expenditures on health.

Recently, the National Medical Commission has notified all medical colleges that they must ensure that an ABHA ID is generated along with patient registration; thereby, their patients and other clinical material will be counted only with ABHA for their permission renewal for student admission.

The 2030 Agenda for Sustainable Development adopted by the United Nations has notified 17 goals, out of which Goal 3 is on good health and wellbeing, which includes the improvement of important parameters like the maternal mortality ratio, under-five mortality rate, and neonatal mortality rate. We hope that ABHA will be an efficient modality to keep up with SDG Goal 3 of the United Nations in our country.

The ABHA web portal is https://abha.abdm.gov.in/abha/v3/. This is user-friendly, where anyone can easily get their ABHA number generated at the hospitals where they get treated or by themselves with their Aadhar number or driving license number.

ABHA is more futuristic with its important features such as the maintenance of electronic health records (EHR) and patient health records (PHR), privacy and confidentiality, portability, and transparency.

What are your thoughts on the privacy, security, and confidentiality of online patient health records in India?

No one asks the bank about their security, even when they have a lot of money in their account, but they ask for health records. It is really a good sign.

Normally, health records can be stored in the cloud or on in-house servers. However, the current trend is to opt for cloud servers due to reasons such as: better access, transparency, and collaboration, cost-effectiveness, lower TCO (total cost of ownership) in terms of maintenance and technical requirements, and easy scalability.

The Health Insurance Portability and Accountability Act (HIPAA) and the General Data Protection Regulation (GDPR) are common compliance regulations on privacy and security adopted for health-related information. Online platforms, which are compliant with such regulations as Zoho for Healthcare, mostly ensure data security and privacy to the maximum extent. Zoho for Healthcare is a sophisticated and comprehensive solution for healthcare providers.

Though we pay attention to data security and privacy on EHR platforms, it is not so when sharing patient-related information via chat or instant messaging. It is ideal to make sure even instant messaging and chat platforms meet security and compliance regulations when we share patient-related information on them. Instant messaging platforms (like Zoho Cliq) where the admin can control activities with roles assigned for group members are ideal for the security of health-related information.

How can hospitals change in terms of recent trends in technology in India?

Positive changes are seen with hospitals adopting technology with the implementation of electronic health records, which makes their operations more efficient, cost-effective, and patient-friendly. Now, it needs more thrust among the doctors practicing in their individual clinics. Health professionals can also look for smart wearables and assistive devices with remote monitoring, which will add value during the hospital stay and extended home care. Anything indigenous to cost control would encourage better acceptance.

Intense advocacy programs on health digitalization and ABHA can be done, where expert groups like the Telemedicine Society of India (TSI) and the Indian Medical Association (IMA), the largest body of medical professionals in the country, can be involved.

It is inevitable that the healthcare industry should be open to technology, from foundational EHR to futuristic artificial intelligence.

How do you see the potential of artificial intelligence (AI) in the healthcare industry?

Artificial intelligence (AI) will be inevitable in healthcare. Though we discuss much about the applications of AI, it is equally important that we evolve and maintain it. AI is like a growing child. It behaves and responds based on the data we feed it and as per the machine learning models. So the data sets are the prerequisite for efficiency in artificial intelligence, which may vary with the geographical region and the population. Healthcare professionals have to create appropriate data sets, in terms of standardized uniform documentation and evidence, after research studies.

Artificial intelligence can play a prominent role in use cases such as virtual consultations, disease diagnosis, prognosis assessment, image processing, medication management, and health monitoring. Also, it is important that health professionals be educated on the appropriate use of AI without compromising human touch with our health seekers.

Being a medical doctor, please let us know about your “touch with technology.”

It is my passion to keep following the tech trends in healthcare. Being a specialist in rehabilitation medicine, I do have certain ideas on remote monitoring in brain and spine injuries and am working on it.

I am pleased to share with Zoho that I am starting my journey as a tech entrepreneur with an online event management portal for healthcare events: drvenue.com. It is expected to launch by the end of July (2024). We hope that it will offer a better experience in healthcare events, both for the organizers and the attendees.

On Doctors Day, what would your words of wisdom be for the younger generation?

Health is not just being without diseases; it is actually a sense of well-being by all means. To be in good health, self-discipline is more important. Have a proper work-life balance. Stay healthy and happy.

Conclusion

India's healthcare industry has transformed significantly through the integration of technology in recent years. The potential of healthcare technology outcomes is enormous, resulting in significant advancements and improvements in patient care, accessibility, and operational efficiency. The healthcare system in India has been significantly transformed by technology with the introduction of various innovations such as telemedicine, EHR, mobile health, HIS, and AI.

The Indian government has implemented several policies and initiatives in the healthcare ecosystem, such as the Ayushman Bharat scheme, the Digital India initiative, the National Digital Health Blueprint (NDHB), and the National Health Stack. The integration of technology in the healthcare system is leading to a paradigm shift towards a more patient-centred, accessible to all, and efficient healthcare system.